Treating Children and Adolescents Via Telepsychiatry

(Part 4 of a 4-part series)

In this installment of "Coping During COVID-19," Psych Congress Steering Committee member Julie Carbray, PhD, FPMHNP-BC, PMHCNS-BC, APRN, shares tips and learnings for treating children and adolescents via telepsychiatry.

Dr. Carbray is Clinical Professor of Psychiatry and Nursing, University of Illinois at Chicago, and Administrative Director, Pediatric Mood Disorder Clinic, Pediatric Brain Research and Intervention Center, Department of Psychiatry, Chicago, Illinois.

At Psych Congress 2020, she presented "Solving Clinical Challenges in Child and Adolescent Psychiatry," a session which addressed complex issues faced by conference attendees in managing children and adolescents.

"Coping During COVID-19" is an initiative designed to provide content and connection to mental health clinicians during the global pandemic.

See more videos with Dr. Carbray:

Part 1: How COVID-19 Is Affecting the Mental Health of Children and Adolescents

Part 2: Minimizing the Negative Impact of the Pandemic on Children and Adolescents

Part 3: Long-Term Effects of the Pandemic in Children and Adolescents 

Read the transcript:

For many of us clinicians, telepsychiatry has been a brand-new frontier. I know it has been for myself. I've had some learnings throughout that I just wanted to share with some of you.

The first is, in doing telepsychiatry with families, there are so many distractions that can really get in the way of your own treatment goals.

What I've found is that it's important for me as a clinician to prioritize, what do I really want to accomplish in this visit with this family to let them know straight away what I'm thinking about and try to wrap it up by the end. There are so many distractions over this venue that can happen, particularly when you're working with an entire family. I like to establish what we're doing in the visit pretty early on, and make sure that we collaborate, and we agree on that.

The second aspect in working with children and adolescents is it seems very important—more important than when we're sitting in the office—to establish some rules around when we meet, what will that look like.

There are just way too many distractions in the home for kids and adolescents. We have to start at the beginning with some expectations around, will there be any play when we're talking? If I meet with the parents, is it OK for the child to play in the background for a little bit and then have the child join?

Some of our families will expect that the child will sit in a chair for the whole telepsychiatry visit. That's very difficult when there's pets and toys and other distractions. We've had to have a discussion, and actually we send some information prior to the telepsychiatry visit that just establishes that the family has a place that's confidential, that they talk and not be as distracted by some external noise, etc. We've had a couple of our patients who actually meet with us in their car or in their bathroom, because that's the only room that they really have that's going to be quiet, safe, and without distraction.

It's important to be able to establish that right away, as well as if the child would like to play, or if they'd like to draw, to just let parents know that that's OK, and to work with the family around the view of the visit, so that some observations can continue to take place.

I can observe the child, watch the child popping about, and what they're doing with their play while I'm talking with the parent. Then allowing a time to very specifically meet with the child and ask questions of the child, but then giving them some freedom to come and go is important as well.

The other thing that gets in the way sometimes is just audio or video. It's funny, because I've had excellent visits with adolescents who are in their bed. I just see their face every so often, but they're so comfortable being in their bed and so quiet, and in their comfortable space, that they're sharing a lot more.

I'll ask to see their face occasionally, but that's less important than that comfort of that environment. Then there's other times when we have a teenager on screen, we're hardly seeing their face, and we're hearing their phone, because it's so easy to hide from distractions.

We've had to navigate, how do we manage audio, video? What kind of a picture do we expect during our visits? As things slip away, as kids get a little more distant over telepsychiatry, we just really ask them what they're about, what that's about. Make it a part of our visit, just like we would if it were happening in our office.

Some of the challenges that you can head off, you can do it in advance by setting those expectations, by discussing treatment course for that day, by connecting closer or further.

I found that, more than in the office, I really need to have my entire focus on looking at the patient. The more I look away from the patient, the more disinterested they are. Unlike in the office, where you might glance down at papers, or turn to your medical record, I really find in telepsychiatry, you need to be very on and connecting.

If you're not, you really begin to lose the engagement of the child or the adolescent. The more you can do that also helps.

I hope these tips might help you, too, as you're crossing into this new frontier. It would be great to hear your tips as you're doing this as well.